Burden Of Health Care Costs Research Articles

The perioperative experience and needs of hepatocellular carcinoma patients in interventional therapy: a phenomenological qualitative study.

This study aims to investigate the perioperative experience and needs of patients with liver cancer for interventional therapy, in order to provide the basis for further improving a patient's medical experience and satisfaction. A semi-structured in-depth interview was conducted for 16 patients with liver cancer in interventional therapy using the phenomenological research method of qualitative research. The themes were analyzed, summarized, refined and extracted using the Colaizzi analytical procedure. The study results revealed that the perioperative experience and needs of patients with liver cancer for interventional therapy could mainly be summarized into seven themes: anxiety, fear and helplessness; not understanding the specific procedures of interventional therapy; worrying that the disease would not be treated as expected; lack of understanding of perioperative adverse reactions and the inability to cope with these; concern on the financial burden of health care costs on families; concerned on the physical and mental health of the dependent; the further improvement of diagnosis and treatment procedures. Patients with liver cancer undergo a complex psychological experience during interventional therapy. In clinical practice, a patient's psychological needs and changes should be valued, in order to provide a targeted psychological intervention, health guidance and social support, thereby improving the medical experience and satisfaction of patients.

Food desensitization

In recent times, the primary approach to treating food allergies involved strict avoidance of the triggering allergen. Many considered this approach as lacking true treatment, leaving patients vulnerable to even small amounts or hidden sources of the allergenic food. Desensitization or Oral Tolerance Induction (OTI) is a studied method aiming for a lasting tolerance to the allergen. The ultimate goal is permanent tolerance, where allergic reactions won't reoccur after new exposure to the triggering allergen, following a period of abstinence. The research mainly focuses on allergen-specific immunotherapy, covering three routes: oral, sublingual, and epicutaneous immunotherapy. Milk, egg, and peanuts are the extensively studied foods due to their prevalence in allergies. The oral route is favored for inducing tolerance because ingestion of a food antigen by a non-allergic individual triggers an active immune response without causing an allergic reaction. The paradigm has shifted from recommending avoidance to early consumption strategies to prevent allergies. The period from 4 to 6 months of age is considered immunologically sensitive, where children with risk factors show increased allergic sensitization risk. Implementing these recommendations, considering family and community preferences, may reduce the burden of food allergies and healthcare costs.

The association of timing of coronary artery bypass grafting for non-ST-elevation myocardial infarction and clinical outcomes in the contemporary United States.

In contrast to the timing of coronary angiography and percutaneous coronary intervention, the optimal timing of coronary artery bypass grafting (CABG) in non-ST-elevation myocardial infarction (NSTEMI) has not been determined. Therefore, we compared in-hospital outcomes according to different time intervals to CABG surgery in a contemporary NSTEMI population in the USA. We identified all NSTEMI hospitalizations from 2016 to 2020 where revascularization was performed with CABG. We excluded NSTEMI with high-risk features using prespecified criteria. CABG was stratified into ≤24 h, 24-72 h, 72-120 h, and >120 h from admission. Outcomes of interest included in-hospital mortality, perioperative complications, length of stay (LOS), and hospital cost. A total of 147 170 NSTEMI hospitalizations where CABG was performed were assessed. A greater percentage of females, Blacks, and Hispanics experienced delays to CABG surgery. No difference in in-hospital mortality was observed, but CABG at 72-120 h and at >120 h was associated with higher odds of non-home discharge and acute kidney injury compared with CABG at ≤24 h from admission. In addition to these differences, CABG at >120 h was associated with higher odds of gastrointestinal hemorrhage and need for blood transfusion. All 3 groups with CABG delayed >24 h had longer LOS and hospital-associated costs compared with hospitalizations where CABG was performed at ≤24 h. CABG delays in patients with NSTEMI are more frequently experienced by women and minority populations and are associated with an increased burden of complications and healthcare cost.

A Self-Care Deficiency Syndrome: Self-Neglect

Self-neglect is the individual's failure to show the necessary attention and care in his own care. Self-neglect manifests itself as non-adherence to treatment, failure to maintain personal and environmental hygiene, and maladaptive health behaviours. At the global level, although self-neglect is frequently seen especially in the elderly population, it is seen in all age groups and especially in disease groups where disability is in question and their caregivers. Self-neglect, which is divided into two categories as intentional and unintentional, is an important cause of morbidity and mortality. Failure to maintain accepted self-care standards caused by self-neglect threatens not only personal but also public health and well-being and increases the burden of health services and health care costs. Self-neglect is difficult to detect because individuals are isolated and do not have the risk of directly harming themselves. Due to reasons such as non-compliance with current treatment, ineffective health management, these individuals' access to the health system is disrupted and the diagnosis and intervention of self-neglect is delayed because they only apply to health services in emergencies. Health professionals working in the field of public health and mental health, especially community mental health professionals, have important responsibilities for the diagnosis and intervention of self-neglect.

A retrospective analysis of neurogenic orthostatic hypotension in long-term care facility residents with recurrent falls

IntroductionApproximately 50 % of residents in long-term care facilities fall yearly and orthostatic hypotension accounts for a significant portion of them. Neurogenic orthostatic hypotension - a subtype of orthostatic hypotension – is important to be recognized as its management is far more complex; undertreatment of these older adults can lead to recurrent falls, high healthcare cost burden, and increased morbidity and mortality. The primary purpose of our study was to describe the rate of neurogenic orthostatic hypotension in older adults in a long-term care facility, with a secondary purpose to describe risk factors for neurogenic orthostatic hypotension in this population. MethodsWe conducted a retrospective case-control study of residents with recurrent falls at the Dayton Veteran's Affairs long-term care facility. Charts were manually reviewed. Inclusion criterion was three or more falls and age 65 or greater; we did not have exclusion criteria.ICD10 codes and most recent primary care physician notes were used to identify comorbidity diagnoses. Recent orthostatic vitals were used to assess orthostatic hypotension or neurogenic orthostatic hypotension diagnoses. ResultsOf our sample of 224 residents, we observed a prevalence of 20.5 % for neurogenic orthostatic hypotension and 32.1 % for orthostatic hypotension. Neither of them had diagnosis of neurogenic orthostatic hypotension documented. Parkinson's disease was associated with neurogenic orthostatic hypotension (OR-4.3; p = 0.002). Hypertension was prevalent in 69.6 % of residents with orthostatic vitals suggestive of neurogenic orthostatic hypotension. ConclusionOlder adults with recurrent falls at a long-term care facility meet criteria for neurogenic orthostatic hypotension diagnosis far more often than is documented. Common comorbidities associated with neurogenic orthostatic hypotension in this population include Parkinson's disease.

Does higher tax rate affect tobacco usage? Unravelling the nexus between tobacco regulatory control and public health concern

ObjectivesBangladesh stands as a prominent global consumer of tobacco, with alarming consequences on public health. The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126 000 lives in 2018, contributing to 13.5% of all deaths in the country. This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden, with a particular emphasis on its implications for public health. MethodsThis study is based on the annual time series data over the period 2000–2020. The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level. This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden. ResultsThe study finds a negative relationship between tobacco tax rate and tobacco consumption. More specifically, the higher tax rate of tobacco (low (β = −0.3495), medium (β = −0.2319), high (β = −0.9033), premium (β = −0.7322), filtered (β = −0.2114), and non-filtered (β = −0.3452) categories) is significant to reduce tobacco use at 1% level of significance. The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable. Finally, the study investigates the impact on health care cost through tobacco consumption, tobacco control law, growth rate, export-import, and tobacco production. The results indicate that tobacco consumption, export-import, and tobacco production increases health care cost burden while tobacco use regulatory decreases it. By reducing tobacco consumption, higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system, promoting healthier lifestyles, and aligning with global health objectives. ConclusionsHigher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco. Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands. Tobacco control laws need to revised and proper implementation should be ensured as well, to achieve the goal of tobacco free Bangladesh by 2040. Tobacco-related diseases, responsible for a significant proportion of deaths in the country, could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation. This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

PP140 Burden of Illness And Health Care Costs In People with Alzheimer’s Disease

IntroductionAlzheimer’s disease (AD), the most common cause of dementia, is becoming increasingly prevalent worldwide. Understanding the current burden of AD is important in health economic evaluations of new therapies. We aimed to estimate the burden of illness, and healthcare costs of people living with AD using a large, comprehensive real-world database in England.MethodsA retrospective cohort study was undertaken in the Discover-NOW dataset, a real-world database containing the linked primary and secondary care electronic health records of ˜3 million people living in North West London, England. Patients diagnosed with AD were followed from the later of 1 January 2010 or AD diagnosis date, to the earlier of 31 December 2021 or end of follow up (maximum 10 years). Baseline prevalence of 33 comorbidities, incidence of 7 outcomes (survival, cardiovascular, care home admission, hepatic and renal outcomes), healthcare resource utilisation and total direct healthcare costs (using National Health Service tariffs and unit cost approaches) were calculated.ResultsOf 18,116 patients diagnosed with AD, at baseline the mean age was 81 years, 62 percent were female, 65 percent were White, 16.5 percent Asian and 8.9 percent Black. At baseline, hypertension prevalence was 60.2 percent, chronic kidney disease 35.5 percent and Type 2 diabetes 22.4 percent. The highest incidence rates across these outcomes were 13.4 (95% confidence interval [CI]:12.2,14.7) per 1,000 person years for stroke, 7.5 (95% CI: 6.6, 8.5) for myocardial infarction, and 83.6 (95% CI: 80.1, 87.0) for care home admission. Median survival was 4.9 years from diagnosis. Their annual total direct healthcare cost was GBP4,547 per patient, of which 58 percent were from hospital admissions. The majority (75%) of healthcare contacts were from primary care. AD patients had an average length of stay of 11.5 days per inpatient admission, and spent on average one week per year as inpatients.ConclusionsAD is associated with high direct healthcare costs, with patients’ annual costs ˜1.7 times that of the UK population. The majority of these costs are associated with inpatient hospital admissions.

Iterative refinement: Developing items to build an assessment of dementia caregivers’ caregiving style

AbstractBackgroundPrior mixed‐methods research has classified 5 distinct dementia caregiving style profiles based on how caregivers vary across 5 domains: understanding of dementia, adaptability, orientation towards oneself vs. the care recipient, emotional expression, and behavioral management. Style profiles have been associated with important care outcomes, yet, for this construct to be useful, it must be measurable. Our study aims to develop the first comprehensive assessment of caregiver cognitive‐behavioral styles for clinical/service utility or self‐assessment.MethodA preliminary item pool of 188 items was developed based on prior research. A literacy review of item content was conducted. Items then went through iterative refinement including: 1) expert review (2 content experts and 1 measurement development expert, with 63 items modified and 66 deleted); 2) cognitive interviews with 7 caregivers (caregivers reviewed each domain’s item set and provided interview feedback on the items, with 4 items modified and 18 deleted); and 3) translatability review for Spanish (review of wording that could impede translation to other languages, with 28 modified and 4 deleted).ResultOur iterative item pool refinement process resulted in 99 items reflective of the 5 domains to be included in psychometric field testing: adaptability (32 items; e.g., I make adjustments to the way I provide care), behavioral management (20 items; e.g., I try to distract the person I care for when they are frustrated), emotional expression (25 items; e.g., I feel positive when it comes to handling caregiving difficulties), understanding (10 items; e.g., I recognize when I need to change how I communicate with the person I care for), and orientation to self or other (12 total; e.g., I do what is best for the person I care for, even at my own expense).ConclusionOur iterative item development process ensures that items developed for a future measure are person‐centered, clear, translatable, and relevant to empirical evidence. The developed items will be field tested among 200 caregivers. This measure is vital to the development of more effective and individualized treatment to enhance caregivers’ ability to support the PLwD, improve outcomes, and reduce the downstream burden of illness and healthcare costs.

EPH185 Healthcare Resource Utilization and Cost Burden Assessment of Patients with Myasthenia Gravis in Denmark, Finland, and Sweden

EPH185 Healthcare Resource Utilization and Cost Burden Assessment of Patients with Myasthenia Gravis in Denmark, Finland, and Sweden

Real-World Treatment Patterns, Outcomes, Health Care Resource Utilization and Cost Burden of Multiple Myeloma in South Korea Using the National Claims Data

Introduction As multiple myeloma (MM) treatments are rapidly evolving, treatment outcomes significantly have improved over the last decade while the disease burden is inevitably rising. Understanding the real-world treatment patterns and health care resource utilization (HCRU) and costs associated with the novel agents is important in evaluating the value of novel treatments. This study aimed to describe the trends of treatment patterns, outcomes, HCRU and cost burden of MM in real-world practice between 2010 and 2020. Methods A retrospective observational study was conducted using the national insurance claims database provided by the Heath Insurance Review and Assessment, which covers the entire South Korean population. MM patients newly diagnosed from January 2010 to December 2019 were followed up from their first MM diagnosis to the earliest of death or the end of study period. An algorithm was developed to identify MM regimens and lines of therapy (LOT); MM drugs prescribed within the first 21 days of LOT initiation were considered to constitute the same LOT, and MM drugs that were not part of the LOT or prescribed after 180 days from the last observed prescription were considered to initiate the next LOT. Time to next treatment (TTNT), treatment duration (TD), and 5-year survival rate were assessed descriptively. Overall survival (OS) was estimated using the Kaplan-Meier method with log-rank test for significance. HCRU and costs were assessed during the TTNT and TD of each LOT. MM-related HCRU and costs included MM and MM-related comorbidities. Results Among 11,450 eligible patients, 3,080 (26.9%) patients received stem cell transplant (SCT) and 9,825 (85.8%) patients received the 1st LOT (1L). Of these patients, 5,346 (46.7%) patients advanced to 2L, 2,759 (24.1%) patients to 3L, 1,431 (12.5%) patients to 4L, and 709 (6.2%) patients to 5+L. In SCT patients, after the novel agent introduction, the most common regimens changed to VT (bortezomib/thalidomide) from T in 1L, KR (carfilzomib/lenalidomide) from V in 2L, P (pomalidomide) from R in 3L, and D (daratumumab) from R in 4L. In non-SCT patients, the most common regimens in 1L (VM) and 2L (R) did not change after the novel agent introduction while P and D became most common from R in 3L and 4L, respectively. Similarly, the most common treatment sequence changed after the novel agent introduction. Most patients received 1L (39.1%) only or up to 2L (22.6%) during the follow-up period; in SCT patients, the most common sequences changed to VT-based (48.1%) and VT-based with subsequent KR-based (12.1%) from T-based (11.7%) and T-based with subsequent V-based; in non-SCT patients, the most common sequence changed to VM-based (30.0%) and R-based from VM-based (24.8%) and chemo-based (11.4%). TTNT decreased as LOT advanced from 571.5 days (time to 2L) to 289.1 days (time to 5+L), and TD of LOT ranged from 200.0 days to 283.7 days. SCT patients showed longer TTNT and TD than non-SCT patients, except for 1L where SCT patients showed shorter TD. The median OS of all patients was 5.49 years, and SCT patients showed significantly longer OS (10.1 yrs) than non-SCT patients (4.0 yrs). The 5-year survival rate of all patients was 50.5%, and the rate decreased as LOT advanced from 36.5% (1L) to 21.1% (5+ L). SCT patients (47.7%) showed higher rate than non-SCT patients (33.8%), and the rate in SCT patients increased from 65.7% in 2010 to 76.5% in 2015. All-cause HCRU was higher in the advanced LOTs compared to 1L, and healthcare cost increased with the LOT advancement after 1L initiation regardless of SCT status or novel agent introduction. The average length of hospital stay per admission was 22.4 days during the follow-up period, and the length of stay also increased as LOT advanced. The overall all-cause HCRU and cost were higher in non-SCT patients and after novel agent introduction. Similar trends were observed in MM-related HCRU and cost (Table 1). Conclusion This large population-based study found that the novel agent introduction has led to the increase of HCRU and costs of MM but was also associated with better treatment outcomes in terms of survival. The HCRU and costs increased with the advancement of LOT. These findings suggest that a comprehensive understanding of economic burden and treatment outcomes would be required for evaluating the value of novel agent and selecting the optimal treatment options.

Preventive Therapies in Peripheral Arterial Disease.

Atherosclerosis, while initially deemed a bland proliferative process, is now recognized as a multifactorial-lipoprotein-mediated inflammation-driven pathway. With the rising incidence of atherosclerotic disease of the lower extremity arteries, the healthcare burden and clinical morbidity and mortality due to peripheral artery disease (PAD) are currently escalating. With a healthcare cost burden of over 21 billion USD and 200 million patients afflicted worldwide, accurate knowledge regarding the pathophysiology, presentation, and diagnosis of the disease is crucial. The role of lipoproteins and their remnants in atherosclerotic vessel occlusion and plaque formation and progression has been long established. This review paper discusses the epidemiology, pathophysiology, and presentation of PAD. PAD has been repeatedly noted to portend to poor cardiovascular and limb outcomes. We discuss major therapeutic avenues for the prevention of major cardiovascular adverse events and major limb adverse events in patients with PAD.

The Reality of Cost Sharing in Japan.

Financial pressure on younger generation is mounting in Japan, a super-ageing society with staggering economy. The revision on the co-insurance rate for 70-74 with "Standard" category was implemented to mitigate such pressure, seeking better balance across generations in sharing the burden of healthcare cost. It raised the rate from 10% to 20% over the period of five years from 2014 to 2018. This report examined how it changed the share of cost sharing (cost sharing as percentage to total healthcare expenditure), among the 70-74 with "Standard" category in Citizens Health Insurance programme in 44 prefectures. It specifically focused on change in the population's actual share of cost sharing (ASCS) that better reflect the genuine amount of payment actually made by the patients themselves. The average ASCS increased from 7.28% (2013) to 10.78% (2019), resulting wider gap from the statutory planned share of cost sharing (i.e., the statutory co-insurance rate of 10% in 2013, and 20% in 2019). Also found was increased variance among prefectural ASCS, which may suggest a possibility of un-designed effect by the revision, of encouraging a move towards ability and willingness to pay. In terms of cost containment effect, Japan needs to consider various non-conventional options, including review of the current use of healthcare resources. First and foremost, however, the true state of cost sharing should be recognized in terms of ASCS and shared more widely as a reality. Such effort is essential in discussion of how to keep embracing the country's life line, UHC.

Incremental health care resource utilization and costs associated among patients with Parkinson's disease psychosis and incident dementia: An analysis of medicare beneficiaries.

Real-world evidence examining the incremental health care resource use (HCRU) and cost burden of incident dementia among patients with Parkinson's disease psychosis (PDP) are needed within the United States (US). To compare HCRU and cost burden between PDP patients with incident dementia (PDP+D) versus without incident dementia (PDP). A retrospective analysis of inpatient (Part A), outpatient (Part B), and prescription drug (Part D) claims from the 100% Medicare sample was conducted to compare PDP+D patients versus PDP patients between 01/01/14-12/31/18. Patients with a diagnosis of dementia, psychosis, secondary parkinsonism, or other psychotic disorders, during 12-month pre-index were excluded. Patients in both groups were matched using 1:1 propensity score matching (PSM) methodology using 31 variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Differences in 12-month post-index HCRU rates and mean per patient per year (PPPY) costs for all-cause inpatient (IP) hospitalizations, and by type of IP stay (i.e., short-term [ST-stay], skilled nursing facility [SNF-stay] and long-term [LT-stay]) were analyzed via logistic and gamma log-link regression models. Of the 12,484 patients who met our study criteria, 1855 PSM-matched cohorts were identified. Mean age, gender, and comorbidities were similar in PSM groups. Approximately, 50.3% with PDP+D reported ≥1 all-cause IP hospitalizations versus 36.0% with PDP (p<0.05) during 12-month follow-up. Specifically, all-cause ST-stay, SNF-stay, and LT-stay among PDP+D versus PDP patients were: 45.2% versus 35.7%, 28.3% versus 15.7%, and 8.5% versus 6.0% (p<0.05), respectively. Psychiatric-related ST-stay, SNF-stay, and LT-stay among PDP+D versus PDP patients were: 12.3% versus 9.0%, 7.5% versus 3.4%, and 2.4% versus 1.2% (p<0.05), respectively. Mean PPPY all-cause IP hospitalization costs for PDP+D patients versus PDP patients was $17,891 (±29,882) versus $11,599 (±$25,247) (p<0.05). Patients with PDP+D experience significantly higher all-cause and psychiatric-related IP hospitalizations, including ST-stays, LT stays, and SNF stays. They also had 54% greater mean PPPY IP hospitalization costs versus PDP patients.

Research progress in pharmacotherapy of insomnia

Insomnia is extremely common and is a risk factor for a variety of physical and psychological disorders in addition to contributing to the reduced quality of life of patients and the burden of healthcare costs. Although cognitive behavioral therapy is the first-line treatment for insomnia, its difficulty of access and high cost have hindered its application. Therefore, pharmacotherapy remains the common treatment choice for patients and clinicians. Existing chemical drugs including benzodiazepine receptor agonists, dual orexin receptor antagonists, melatonin and its receptor agonists, histamine antagonists, antidepressants, and antipsychotics are able to induce and/or maintain sleep and have good therapeutic effects on acute insomnia, but their efficacy on chronic insomnia is indefinite. Furthermore, they have several side effects and affect sleep structure and physiological function. Under the guiding principle of holistic view and treatment based on syndrome differentiation, traditional Chinese medicine(TCM) has shown a good effect in clinical practice, but with little high-grade clinical evidence. The mechanism, dose, half-life period, adjustment of sleep structure, and side effects of hypnotic drugs are key factors to be considered for clinical use. This paper analyzed and summarized the drugs for insomnia from the above aspects, and is expected to provide references for the application and development of sedative and hypnotic drugs.

PB0324 Burden of Symptoms and Healthcare Resource Utilization (HCRU) and Costs in U.S. Patients with Thrombotic Thrombocytopenic Purpura (TTP)

PB0324 Burden of Symptoms and Healthcare Resource Utilization (HCRU) and Costs in U.S. Patients with Thrombotic Thrombocytopenic Purpura (TTP)

Healthcare costs associated with opportunistically identifiable vertebral fractures.

Vertebral fractures (VFs) are often available on radiological imaging undertaken during daily clinical work, yet the healthcare cost burden of these opportunistically identifiable fractures has not previously been reported. In this study, we examine the direct healthcare costs of subjects with vertebral fractures available for identification on routine CT scans. Thoracolumbar vertebral fractures were identified from 2000 routine CT scans. Subjects with VF on the scan were matched 1:2 against subjects with no VF on the scan, and similarly in a 1:3-ratio against a general population cohort. We excluded those subjects who received treatment with osteoporosis medication(s) in the year prior to baseline. Direct healthcare costs, identified from the national Danish registers, were accrued over up to 6years of follow-up, and reported per day at risk and per year. In subjects undergoing a CT scan, costs were initially high, yet declined over time. Comparing subjects with prevalent vertebral fracture (n=321) against those subjects with no vertebral fracture (n=606), mean total healthcare costs per day at risk was numerically higher in the first three years after baseline, while healthcare costs per year were similar between the cohorts. No differences reached statistical significance. When compared to the general population cohort, costs were significantly higher in the vertebral fracture cohort. Subjects with vertebral fractures available for identification on routine CT scans incur substantially higher healthcare costs than matched subjects representing the general population, and numerically, albeit non-significantly, higher healthcare costs per day at risk in the short term, as compared to subjects with no visible VF on the CT scan.

Uropathogenic Escherichia coli (UPEC)-Associated Urinary Tract Infections: The Molecular Basis for Challenges to Effective Treatment.

Urinary tract infections (UTIs) are among the most common bacterial infections, especially among women and older adults, leading to a significant global healthcare cost burden. Uropathogenic Escherichia coli (UPEC) are the most common cause and accounts for the majority of community-acquired UTIs. Infection by UPEC can cause discomfort, polyuria, and fever. More serious clinical consequences can result in urosepsis, kidney damage, and death. UPEC is a highly adaptive pathogen which presents significant treatment challenges rooted in a complex interplay of molecular factors that allow UPEC to evade host defences, persist within the urinary tract, and resist antibiotic therapy. This review discusses these factors, which include the key genes responsible for adhesion, toxin production, and iron acquisition. Additionally, it addresses antibiotic resistance mechanisms, including chromosomal gene mutations, antibiotic deactivating enzymes, drug efflux, and the role of mobile genetic elements in their dissemination. Furthermore, we provide a forward-looking analysis of emerging alternative therapies, such as phage therapy, nano-formulations, and interventions based on nanomaterials, as well as vaccines and strategies for immunomodulation. This review underscores the continued need for research into the molecular basis of pathogenesis and antimicrobial resistance in the treatment of UPEC, as well as the need for clinically guided treatment of UTIs, particularly in light of the rapid spread of multidrug resistance.

Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol

Background: A robust Health Technology Assessment (HTA) mechanism is crucial to address the rising burden of healthcare costs and expenditures of patients. This research aims to describe the HTA methods and mechanisms for successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Methods: Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. Conclusions: To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study.

The incidence of inappropriate and excessive empirical antibiotic therapy is unclear. The aim of this study was to determine the prevalence of different empirical antibiotic therapy prescriptions, related factors, and outcomes in hospitalized patients with bacterial infection. A retrospective cohort study was performed and patients with bacterial infection who were admitted between October 1, 2019, and September 30, 2020, were included. Multivariable analysis was performed by the logistic regression model. A total of 536 (42.6%) of the 1257 included patients received inappropriate empirical antibiotic therapy (IEAT), and 368 (29.3%) patients received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT). MDRO (adjusted OR 2.932 [95% CI 2.201~3.905]; p < 0.001) and fever on admission (adjusted OR 0.592 [95% CI 0.415~0.844]; p = 0.004) were correlates of IEAT; sepsis (adjusted OR 2.342 [95% CI 1.371~3.999]; p = 0.002), age (adjusted OR 1.019 [95% CI 1.008~1.030]; p < 0.001), MDRO (adjusted OR 0.664 [95% CI 0.469~0.941]; p = 0.021), and urinary tract infection (adjusted OR 0.352 [95% CI 0.203~0.611]; p < 0.001) were correlates of AUEAT. Patients who received AUEAT were more likely to have a poor prognosis (63 [17.8%] vs 101 [27.4%]; p = 0.002). Both IEAT (median [IQR], 24,971 [13,135-70,155] vs 31,489 [14,894-101,082] CNY; p = 0.007) and AUEAT (median [IQR], 24,971 [13,135-70,155] vs 30,960 [16,475-90,881] CNY; p = 0.002) increased hospital costs. 45.3% (570/1257) of patients were infected with MDRO and 62.9% of them received IEAT. Inappropriate and excessive empirical antibiotic use was widely prevalent among hospitalized patients. Either inappropriate or excessive use of antibiotics may increase the burden of healthcare costs, the latter of which may be associated with poor prognosis. Clinicians need to be more judicious in choosing antibiotic(s). The MDRO epidemic was severe, especially in patients who received IEAT. It is imperative to take effective measures to improve the current situation of antibiotic abuse and antimicrobial resistance.

Characteristics associated with receipt of treatment among patients diagnosed with chronic hepatitis C virus.

Although current guidelines recommend that nearly all patients with chronic hepatitis C virus (HCV) infection receive treatment, a substantial proportion remain untreated. We conducted an administrative claims analysis to provide real-world data on treatment patterns and characteristics of treated versus untreated patients among individuals with HCV in the United States. Adults with an HCV diagnosis from 01 July 2016 through 30 September 2020 and continuous health plan enrolment for 12 months before and ≥1 month after the diagnosis date were identified in the Optum Research Database. Descriptive and multivariable analyses were conducted to evaluate the association between patient characteristics and the rate of treatment. Of 24,374 patients identified with HCV, only 30% initiated treatment during follow-up. Factors associated with increased rate of treatment included younger age versus age 75+ (hazard ratio [HR] 1.50-1.83 depending on age group), commercial versus Medicare insurance (HR 1.32), and diagnosis by a specialist versus a primary care physician (HR 2.56 and 2.62 for gastroenterology and infectious disease or hepatology, respectively) (p < .01 for all). Several baseline comorbidities were associated with decreased rate of treatment, including psychiatric disorders (HR 0.87), drug use disorders (HR 0.85) and cirrhosis (HR 0.42) (p < .01 for all). These findings highlight existing HCV treatment inequities, particularly among older patients and those with psychiatric disorders, substance use disorders or chronic comorbidities. Targeted efforts to increase treatment uptake in these populations could mitigate a considerable future burden of HCV-related morbidity, mortality and healthcare costs.